Neurosafe Technique or Retzius Sparring Technique

They are not alternatives - they are different things, and as far as I know, they can be done together.

Retzius sparing is a different way of dissecting out the prostate which avoids damage to an anatomical area called the Cave of Retzius. This tends to give a faster recovery of urinary continence after the operation, but 6-12 months later, Retropubic (standard) RALP patients have caught up. Another significant factor is it tends to be only the most experienced surgeons who do Retzius sparing RALP.

Neurosafe (also called Frozen Sections) is a technique for avoiding positive margins, and may improve the chances of nerve sparing without increasing the risk of positive margins. Positive margins are where not all the cancer was cut out, and without Neurosafe, it's not normally discovered until after the operation and it's too late to fix it in the operation, and radiotherapy is likely to be required. Neurosafe enables the positive margin to be seen while you're still in theatre, enabling it to be cut away.

There's an alternative procedure using a Histolog Scanner which does the same job as Neurosafe, which some hospitals are just starting to use. (It doesn't require the Histopathologist to be in/near the operating theatre, as it works across the Internet.)

As to which to chose if you can only have one, I think this depends if faster return of urinary continence (Retzius sparing) is more important to you than reducing the risk of needing salvage radiotherapy (Neurosafe). There are no guarantees either way though.

I'm having RARP on 8/04 and spent a lot of time researching surgeons, locations and the different types of robotic machines. Andy is right, Retzius is offered by the surgeon and also possibly dependant on the robot he/she uses. Neurosafe can only be offered if facilities allow and the surgeon is prepared to do this. I'm fortunate in that living just outside London I have a wide choice. Interestingly I found that the Royal Marsden despite having latest equipment and a superb reputation doesn't offer Neurosafe. I'm off to central London where the surgeon will use the Da Vinci SP (Single Port) robot. One incision not multiple which makes initial recovery quicker although outcomes in the medium & longer term are the same. Good luck with your decisions, it's not easy. If you want more information on surgeons and locations please message me.

Best of luck on your surgery. Guys London Bridge is epic centre. Recommend taking a media box and long hdmi lead plus power leads then you can have your own choice tv. The food there is epic. 

Interesting response. In around ~44% cases post surgery histology upgrades the cancer. I learnt the hard way as I’d had the latest tech 3T mpMRI and the spread was more extensive than shown in the images. Bit of an eye opener. With me NeuroSAFE showed suspicious margin so the surgeon took more tissue while I was open. Histology actually showed it was a false positive but thus far 5yrs post retzius RARP I’m PSA undetectable 🤞

Hi Adrian

Yes it does seem strange at first sight but if you look at the details only a very small proportion (less than 6%) of their total sample were deemed to be low risk.

This lends support to their suggestion that their low risk sample may not be representative of all low risk cancers since the proportion of all prostate cancers which are low risk must be much higher than that.

One of their tables also shows that the great majority of Grade 6 upgrades were to 3+4, which means that they might still have been able to continue on AS if they had opted for it.

Best wishes

Kevin